| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $750.36 | $750.36 | $8,500.00 | |
Aetna
| Facility | 54 | $562.77 | $562.77 | $562.77 |
Medica
| Facility | $750.36 | $931.18 | $1,275.60 | |
United
| Facility | $3,105.02 | $3,105.02 | $3,105.02 |